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Three Part Question

In [Frontline nurses works in the era of COVID-19 pandemic], does [the higher level of burnout] result in [lower level of resilience]?

Clinical Scenario

Your Head of Department is considering the implementation of psychological support for staff with poor resilience. He is wondering whether the COVID-19 pandemic worsens the level of resilience of frontline nurses during the COVID pandemic.

Search Strategy

Medline 1966-04 using the OVID interface

Title and Abstract: (COVID OR COVID-19 OR coronavirus OR SARS-CoV-2) AND (Resilience) AND (Nurse)

Further limit to papers published in English language and full text available

Search Outcome

30 papers were identified. After a review of the abstracts, 4 were deemed relevant to the discussion.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Kelker, Yoder, Musey, et al 24 March 2021 USA	213 EM physicians and advanced practice providers (e.g. nurse practitioners and physician assistants)	Prospective study	Resilience (Brief Resilience Scale) during the initial acceleration phase of COVID-19	Baseline resilience was normal to high.	This paper had several weaknesses, including a small sample size and voluntary response bias because an online survey as an instrument.
Munn, Liu, Swick et al August 2021 USA	6,120 nurses, advanced practice providers, certified registered nurse anaesthetists, respiratory therapists, health care technicians, and therapy service professionals.	Cross-Sectional Study	Resilience	Four factors found to have significantly associated with higher resilience, including Feeling that the organization understands the emotional support needs of healthcare workers during the pandemic; Believing that sufficient educational resources were available to help workers safely care for COVID-19-positive patients; Having positive perceptions of leadership support from direct managers; Believing that staff redeployment to critical areas was necessary to meet patient and team needs.	This study took place in a single healthcare system, and around half of the targeted participants rejected to participate. Hence, the generalizability of findings from this study might be limited.
Phillips, Knowlton, and Riseden June 15, 2020 USA	16 articles	Integrative literature review	Resilience	Self-discipline, optimism, goal-oriented behaviors, and decisive-action characteristics formulate an ED nurse with high levels of resilience.	The chances to be biased in this review increase as there is no set method to confirm all literature on the topic to be considered.
Parizad, Soheili, Powers et al 15 December 2021 Iran	233 nurses working at three urban teaching hospitals in the northwest of Iran	Descriptive cross-sectional study	Overall resilience scores	A moderate to high level of resilience in nurses	Research conducted in a small region of Iran, the generalizability of the study finding might be questioned. Also, the study may be biased as a self-reported questionnaire has been adopted as the research instrument.
			Correlation between Demographic characteristics and resilience	Having family support positively affected nurses' resilience.

Comment(s)

There is a moderate to high level of resilience in frontline nurses in the COVID era.

Clinical Bottom Line

In the era of the COVID pandemic, although there is a high level of burnout, multiple studies still showed there is a moderate to high level of resilience in frontline nurses.

References

1. Kelker, Yoder, Musey, et al Prospective study of emergency medicine provider wellness across ten academic and community hospitals during the initial surge of the COVID-19 pandemic BMC Emergency Medicine 24 March 2021; 21(1):36
2. Munn, Liu, Swick et al Original Research: Well-Being and Resilience Among Health Care Workers During the COVID-19 Pandemic: A Cross-Sectional Study American Journal of Nursing Volume 121(8), August 2021, p 24-34
3. Phillips, Knowlton, and Riseden Emergency Department Nursing Burnout and Resilience Advanced Emergency Nursing Journal Volume 44(1), January/March 2022, p 54-62
4. Parizad, Soheili, Powers et al Level of resilience in nurses working at COVID-19 referral centers in Iran. Nursing forum 57(3):344-351, 2022 May.